Prolotherapy is such a wonderful treatment. It can make a big difference to pain reduction and to correcting instability in the body. It is a privilege to be on the teaching team heading to Calgary in September, Covid-precautions permitting, to train 20 physicians from across Canada. We hope this will lead to easier access to prolotherapy for more people, as more physicians become proficient in the treatment :-)
Please see our updated handout answering many of your commonly asked questions, under the FAQ page, and then the PRP page. Note that this can also be used following prolotherapy for optimal recovery. There are detailed instructions on what exercises should be done when, along with other tips and instructions. Thanks to Dr Annette Zaharoff for a lot of the information included in the handout. She is a colleague in Texas, who also used to be a professional tennis player, so she knows a thing or two! She has an avid interest in "prehab", ie. getting you prepared for PRP, as well as optimal "rehab" afterwards, and is very knowledgeable in these areas. Please spend time reading this handout before your PRP appointment for best results! A copy is attached here.
A study has been published, showing a significant rise in your platelet count (and thus also the number of platelets you will have when we draw your blood) in response to exercise. Specifically this was after 4 minutes of high intensity training (HIT), tested on a stationary bike. We can probably assume if you do this within 30 mins or less of your blood draw, ie. stop for a quick sprint/jog/aerobic activity (raising your heart rate) to the best of your ability, we will get better platelet counts. If you don't have a heart condition, consider doing this at the Interurban Rail Trail (on the Prospect Lake Rd side of the West Saanich/Prospect Lake intersection) or at the Whitehead park which is minutes from our clinic. Make sure you tell the receptionist as soon as you arrive, so that we can take your blood sample as quickly as possible, for the best result!
Hot off the press is the article I co-wrote with colleagues Drs. Harrison and Levins, on comparing platelet yields using 6 different preparation methods. While this is more of a basic science and technical paper, the bottom line is there is a lot one can do to produce high quality, effective platelet-rich plasma (PRP) to facilitate healing from many chronic musculoskeletal pain conditions. This paper can be found on our research page, under the PRP section. We have already started work on a second paper!
Toronto and the CAOM
I have recently attended the annual Canadian Association of Orthopaedic Medicine conference, this year held in the big TO. As usual there were some excellent presentations and workshops, and I left feeling inspired and privileged to be working in musculoskeletal pain management. There was a lot of focus on nutrition: so much of pain can be attributed to the foods we eat! Also there was an excellent talk on genetic testing - knowing one's genome can help tailor treatment very specifically and even prevent certain problems/diseases from occurring. I presented a workshop on the hydrodissection of peripheral nerves using 5% dextrose under ultrasound guidance, along with a colleague, Dr Jag Gupta. This was well-attended, showing the interest in treating neuropathic pain without using drugs which have many side effects (aka brain fog). Dr Gordon Ko organised a terrific conference and I hope to incorporate new pearls of wisdom into my practice!
Back Pain and Exercise
Medical Ozone Injections
After reviewing the medical literature we have decided to offer medical ozone injections to relieve painful joints. We are excited at this addition to our practice as it is yet another excellent option for the treatment of pain. It has been used for many years in Europe with success, and there are many studies on its use and effectiveness in the literature. We will be posting some of these under our research page in the near future. Medical ozone is injected into the affected joint following a local anaesthetic injection and is well-tolerated.
University of Alberta Pain Certification
David and I have enrolled in a recent pain management certificate program at the University of Alberta. We never stop learning! Things have certainly changed since we were undergraduates. Over the next couple of years we'll be participating "virtually", attending "e-classes" and online lectures, submitting assignments electronically, searching virtual libraries and accessing a wealth of material, adding citations with a computer-generated program that automates the process so quickly, and best of all, able to enjoy Victoria instead of the frozen north!
Botox injections can provide very effective relief from migraine. If you have an extended medical plan this treatment may be more affordable than you think. Botox is thought to mediate pain by blocking the release of substances our bodies make (CGRP) which cause pain, as well as by relaxing some of the tense muscles around the face and neck. It prevents or lessens migraine intensity and frequency for at least 3 months before it needs to be repeated again. The procedure involves very superficial injections with tiny needles and is tolerated well and doesn't take long. Relief is in sight! Note: this is a preventative treatment meaning if it is effective, you won't suffer nearly as many migraines during the 3 months after treatment.
An interesting study was published recently. Having a knee arthroscopy (a surgical procedure with a "telescope" looking into the knee, and cleaning out any part that is rough or loose) does not improve pain. Many, many people suffer from knee arthritis and so this is helpful in deciding on a course of action. Having a knee replacement may be the eventual answer, but in the mean time regenerative injections (perineural injecting of dextrose, or prolotherapy, or PRP) can be a big help in reducing symptoms, and may even prevent the "kneed" to do surgery at all.
Jannice is a family physician with an interest in the treatment of pain. Anything to help the process is added to this blog.